Font Size

Pharmacy Prior Authorization

Pharmacy Fee For Service Prior Authorization (PA)  Contacts

Change Healthcare Pharmacy PA Unit
Toll-free: 877-537-0722
Fax: 877-537-0720

Registered Users in the Change Healthcare PA Portal
If you are a Mississippi Medicaid prescriber, submit your Fee For Service prior authorization requests through the Change Healthcare provider portal.

Drug Prior Authorization Instructions

Prior Authorization Packets Updated
Brand Name Multi-Source 6/21/2019
Early Refill 6/21/2019
Enteral Nutrition 6/21/2019
EPSDT – Beneficiaries Under 21 6/28/2019
Hepatitis C Therapy 6/1/2021
Max Unit Override 6/21/2019
Multiple Concurrent Antipsychotics for Beneficiaries (Age < 18) 6/21/2019
Opioid Packet – Effective 8/1/2019       FAQs 9/10/2019
PDL Exception Request 6/21/2019
RSV-SYNAGIS® 7/16/2021
Universal Prior Authorization Form 6/21/2019


Manual Prior Authorization Criteria

Pharmacy Reconsideration Request Form

MedWatch Form